Release from incarceration during the concurrent COVID-19 and opioid use crises

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Kate McLeod is a PhD Candidate in the University of British Columbia School of Population and Public Health

Ruth Elwood Martin is a Clinical Professor in the University of British Columbia Faculty of Medicine and Director of the Collaborating Centre for Prison Health and Education

On April 2, Dr. Bonny Henry confirmed the first case of Covid-19 in a BC correctional facility. This comes as no surprise. For weeks experts have been highlighting the high-risk environment people in prisons are exposed to.

Inside correctional facilities there is unavoidable close contact and a high degree of movement between prisons and the community as staff and new intakes move in and out. This increases the risk of SARS-CoV-2 infection for both incarcerated people and staff and their families. People in prisons are also more likely to have a preexisting health conditions such as HIV, hepatitis C, respiratory and cardiovascular diseases that increases their risks for complications with COVID-19.

Recent media reports have provided a glimpse of the fear and powerlessness people who are incarcerated and their families are feeling. There have been many calls to release incarcerated people, including those from Correctional Investigator Ivan Zinger, former Health Minister Jane Philpott and Senator Kim Pate.

Releasing people from the high-risk environment that is incarceration is important, but so is knowing what people are being released to. Many people in BC and across Canada are sentenced to facilities far from their home. Airports in many small communities are closing and Ebus (formerly Greyhound) have reduced their services in BC and Alberta, leaving many without a way to get home. Community resources such as treatment centres and shelters are no longer accepting new clients, so those who can’t get home have few other places to go.

A majority of people engaged by our prison systems use substances. The illicit drug supply is likely to become even less stable as closed borders interrupt supply chains, which means that people who use substances now face two simultaneous crises. British Columbia’s Centre on Substance Use recently published updated guidance on providing safe supply for opioid users. This is an essential component of the response to both public health crises, but it is not itself sufficient to keep people safe. Without thoughtful, comprehensive supports for people released from incarceration we will inadvertently structure an environment where unsupported release exacerbates substance use crises in communities like Vancouver’s downtown East Side, creating a cycle of exposure and risk that puts all communities at risk.

Earlier this year, CMAJ Open published our report of the work and importance of the Unlocking the Gates (UTG) peer health mentoring program which supports people leaving prisons in BC. For the first 72 hours after release, UTG peer health mentors, who have all experienced incarceration themselves, help people to connect with essential resources such as transportation home, clothing, food, shelter, healthcare and addictions services. In the weeks since COVID-19 became an increasing threat in our communities, UTG peer health mentors have continued to work as one of the only remaining supports available to people leaving prisons. Since many community organizations are closed, people leaving prisons are left with few available supports to keep themselves safe. In a time of dual public health crises, the barriers and risks for people leaving prison require urgent, collective action to ensure the safety of people and communities.

On April 5, the UBC Collaborating Centre for Prison Health and Education, where the Unlocking the Gates Program is based, released an open letter to BC Ministries calling for targeted resources to support people leaving prisons. UTG peers have identified three areas of urgent concern requiring funding and action: 1) ensuring that people have a way home after they are released; 2) providing housing that allows people to self-isolate after being released from prison (similar to guidance given for people returning from international travel) such as hotel rooms in their home communities; and 3) ensuring that people have mental and emotional health supports during their 14-day isolation, such as peer support and a cell phone so they can stay in touch with loved ones.

Prison health is an intrinsic part of public health. Like few emergencies before, the COVID-19 pandemic has highlighted how much we are each connected with every other member of our community. The barriers faced by people leaving prisons puts all communities at risk, and it is up to all of us as government, healthcare providers, community organizers and members of the public to address these urgent needs.

“We’re just at the beginning of the problems for people coming out. We’re going to be seeing a lot more hard stories.” – Mo Korchinski UTG Program Manager.